ISPOR 2008 International Fellowship Report: Is it Time to Think Seriously About Making HTA Available in Settings Where There is the Most Need?

No one would argue that priority setting is most critical in settings where resources are most constrained and that the well-planned and efficient use of scarce resources will yield the most benefits to those societies. Unfortunately, health technology assessment (HTA), regarded as one of the major disciplines for health priority setting, is largely developed in only resource-rich countries [1]. At present, the majority of countries in Western Europe and North America have  their  own  systems  for  HTA  and  formally  use  this  evidence  for  making health policy decisions. In contrast, there are only a few countries in Asia and Latin  America  that  are  in  infant  phase  for  incorporating  HTA  into  the  health policy development process, while the majority of the countries in these two continents and most countries in Africa still severely lack HTA capacity [2, 3].

I appreciate the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) in acknowledging this problem and the fact that the organization established the ISPOR International Fellowship Award to support individual scholars from economically disadvantaged countries. These scholars participate in its academic activities with the hope that it will bring them in contact with a worldwide network and give access to knowledge to make their local HTA systems stronger. It was my great honor to be selected as one of the recipients of a prestigious 2008 ISPOR International Fellowship.

In 2007, I set up the Health Intervention and Technology Assessment Program (HITAP) with an initial plan and a budget for three years. Thank to the tireless efforts of all HITAP staff, our achievements far exceeded our initial expectations. Currently, decision makers in Thailand widely recognize the usefulness of HTA and there is an increasing demand for it. This is well reflected in the HITAP evaluation report described by the national and international experts who assessed the program in 2009 as follows: “HITAP has made significant progress with respect to fulfilling all four strategies. Since its establishment in early 2007, there have been significant improvements in the infrastructure for undertaking HTA in Thailand (e.g. Thai database; training and capacity building; methods guidelines) and also in the way HTA evidence feeds into policy. Consistent to its mission and vision and within a short timeframe (two years) and relatively limited human and financial resources, HITAP has managed not only to develop a set of robust methods to guide the consistent and transparent development of HTA research (strategy I), but also to deliver on a large number of specific HTA products (strategy III) with often significant influence on policy and practice (strategy IV), while, at the same time, strengthening the country’s HTA capacity (Strategy II). HITAP’s impact has been national and international, with formal agreements with agencies in Korea (HIRA) and the UK (NICE) as well as international academic institutions. HITAP can serve as an international model for other low and middle income countries interested in setting up HTA agencies, and for international funding agencies around the world.” [4]

I wrote this report at a time when HITAP has secured another 3-year financial support period from four major stakeholders within the Thai health care system. These include the Thai Health Promotion Foundation, the Health Systems Research Institute, the Ministry of Public Health and the National Health Security Office. In this term these public health authorities have nearly doubled their support to HITAP. They do not only acknowledge the importance of HTA, but also they trust in the systems and mechanisms for which HITAP has been developed. HITAP has adopted the principles of technical excellence, policy relevance, transparency, effective communication, and participation of key stakeholders. These principles have been translated into good practice at every step of HTA management and they have been described in detail in two articles recently published in international journals [5, 6]. It is hoped that the lessons drawn on the creation of HITAP and its experience, including information regarding its main strategies and management structures, will be helpful for other resource-constrained countries in thinking how best to strengthen their capacity to assess health technologies and interventions for their own settings.

I take this opportunity to thank the ISPOR for its support for me to attend the two Annual European Congresses in Athens and Paris where I made many friends and gained a lot of insightful experience and information about health economics and outcomes research. Furthermore, because I feel certain that HTA will become a global trend in the near future, I would like to encourage every scholar and decision maker in settings where there is no existing mechanism for HTA to promptly build up HTA capacity and infrastructure. My last point to be addressed is all the so-called ‘secrets of success’ (in making HTA available) will not work unless you dare to do it.

References

1. Singer ME. Cost-effectiveness analysis: developing nations left behind. Pharmacoeconomics 2008;26:359-61.
2. Iglesias CP, Drummond MF, Rovira J. Health-care decision-making processes in Latin America: problems and prospects for the use of economic evaluation. Int J Technol Assess Health Care 2005;21:1-14.
3. Tarn YH, Hu S, Kamae I, et al. Health-care systems and pharmacoeconomic research in Asia-Pacific region. Value Health 2008;11(Suppl. 1):S137-55.
4. Panpiemras J, Suriyawongpaisal P, Cairns J, Chalkidou K. Evaluating HITAP: 2 years on. Bangkok: Health Intervention and Technology Assessment Program; 2009.
5. Teerawattananon Y, Tantivess S, et al. Historical development of health technology assessment in Thailand. Int J Technol Assess Health Care 2009;25(Suppl. 1):241-52.
6. Tantivess S, Teerawattananon Y, Mills A. Strengthening cost-effectiveness analysis in Thailand through the establishment of the health intervention and technology assessment program. Pharmacoeconomics 2009;27:931-45.

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